Childhood immunization in India: Roles of family structure, women's autonomy, and village health service provision

Shengchao Yu, University of Pennsylvania


Despite previous efforts made by the Indian government, rates of childhood immunization are still low; and there is gender inequality in the access to immunization. Analyzing the 1998–99 India National Family Health Survey (NFHS) data, I investigate the causes of the low levels of immunization in India from three perspectives: sibship composition, women's autonomy, and village health services. I first examine whether the gender difference in childhood immunization is related to sibship composition. The results show that female disadvantages in childhood immunization concentrate among girls with one or more surviving older sisters. Parents do not regard sons and daughters as exact substitutes in the household. Instead, they appear to prefer for a balanced number of children of each sex. I then address the question that whether women's autonomy affects childhood immunization. Three direct measures of women's autonomy, decision-making power in household, freedom of movement, and control over money, exert positive impacts on childhood immunization. This analysis emphasizes the importance of appropriate measurement of women's autonomy in the study of health service use. Finally, my results suggest that community health services and information, education, and communication (IEC) activities improve immunization levels and reduce drop-out of the multi-doses vaccinations. This dissertation also implies that health program placement should consider demographic and socioeconomic background of the vaccine recipients. Overall, my dissertation considers both the individual-level demographic and socioeconomic background and the community-level infrastructural conditions, and it takes into account both demand and supply side factors that determine the immunization coverage. Further, I address the potential sample selection bias problem by adopting Heckman's two-stage approach, which allows me to draw on information from non-surviving children to improve the estimates of the parameters in the regression models. My dissertation suggest that more policy emphasis should be directed towards the most disadvantaged groups, that is, girls with one or more surviving older sisters. To improve the overall childhood immunization, I emphasize the fundamental role of women's autonomy, and the significance of community driven participatory approaches.

Subject Area

Demography|Public health|South Asian Studies

Recommended Citation

Yu, Shengchao, "Childhood immunization in India: Roles of family structure, women's autonomy, and village health service provision" (2004). Dissertations available from ProQuest. AAI3152130.